MEDICARE: DR. CHERYL VICTORIA BRONNER PHD, PT, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	008223-1	NY

General Provider Information

NPI Number	:	1285763854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL VICTORIA BRONNER PHD, PT, OCS

Provider Business Mailing Address
First Line	:	90 8TH AVE
Second Line	:	#11B
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1553
Country	:	US
Telephone Number	:	718-246-6377
Fax Number	:	718-246-6383

Provider Business Practice Location Address
First Line	:	122 ASHLAND PL
Second Line	:	#1A
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3973
Country	:	US
Telephone Number	:	718-246-6377
Fax Number	:	718-246-6383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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